Identifying and Treating Depression

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Insights and advice to support older people with dementia.

Depression in older people, especially older people with dementia, is common, under-recognized, and is definitely not a part of normal aging. Figuring out whether an elderly person is depressed is understandably difficult. Many elderly people have no psychological problems other than feeling isolated, depending on others, being in pain and dealing with the death of friends and loved ones. Of course, these things make for unhappiness, but we may decide that a depressed elderly person is just having a "normal" reaction to a life full of difficulty.

The presence of dementia makes a depression diagnosis even more difficult. Sometimes these patients can't express their distress, have forgotten particularly unhappy events, or appear sad and morose as a feature of their dementia— not of depression.

Unlike with younger people, in the elderly, the boundaries for identifying depression become blurred. For example, if a younger person has problems sleeping, it will prompt professionals to look for the other characteristics of a depressive illness. But normal sleep for elderly people is often interrupted in the absence of depression.

Things to consider

If you have an older friend or relative whom you suspect may be depressed, possible questions to ask include:

  1. Has there been a recent change? Such as low energy, poor sleep, more irritability or fewer activities?
  2. Is the person talking about being worthless, helpless or wishing to die?
  3. Do they want help and are they willing to try to get better?
  4. In people with dementia, are there troubling features beyond their forgetfulness, such as weight loss, excess irritability, poor sleep and severe fatigue or lack of energy?

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Treatment options

Treating suspected depression in an older person is, like with many other therapies, usually a careful experiment. Drugs, talk therapy and even shock therapy (ECT) are some possibilities. No depression medication is necessarily better than any other in older people. Safe, successful drug treatment means carefully reviewing the suspected problem and looking in detail for side effects.

Most antidepressants take several weeks to work, so this takes time. In dementia, it's particularly important to continually review the response to trials of medication, watching carefully for general improvement or deterioration, as well as any expected specific benefits or side effects.

Talking to a psychiatrist, psychologist or other trained therapist can make all the difference to a depressed older person. This is, of course, more difficult if the patient has memory problems.

Strange as it may seem, electroconvulsive therapy (ECT), often thought of as barbaric and old-fashioned, may be safer and better in severely depressed older people than other types of treatment.

Try to pay attention to your elderly friends and loved ones, consider depressive illness if there are problems, and gently try to encourage social contacts, sincere conversation, and, of course, exercise.

ABOUT THE AUTHOR

Dr. John Sloan is a family physician whose practice is confined to home care of frail elderly people, avoiding institutional care of these patients. A clinical professor in the Primary Care Geriatrics program at the University of British Columbia, he has published numerous articles and several books on health care. He lives with his family in Roberts Creek, B.C..

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